Review clinical information to meet Medical Necessity Criteria.
Requires knowledge of managed care contracting and clinical review requirements.
Ensures accurate information is entered into claims system.
Sentara Health is a not-for-profit integrated healthcare provider based in Virginia and Northeastern North Carolina that has been in business for over 131 years. It has close to a 30,000-member workforce, and diversity, inclusion, and belonging is a guiding principle of the organization.
Help members stretch their food budgets and make the most of what they have.
Guide access to affordable, healthy groceries through our online marketplace.
Connect members with local food and nutrition resources.
Foodsmart is the leading telenutrition and foodcare solution, backed by a robust network of Registered Dietitians. They guide members on a tailored journey to eating well while saving time and money. In 2024, Foodsmart secured a $200 million investment and is committed to a set of core values that shape the culture and work environment.
The National Onc MOSL proactively identifies key national oncology healthcare decision makers (HCDMs) and builds strong relationships to understand customer needs.
Serve at a management/leadership level in oncology therapeutic area and healthcare landscape strategic planning and issue resolution.
Anticipate, identify and address population-level scientific, outcomes research, and health policy needs of customers serving as the trusted advisor to the customer.
AbbVie discovers and delivers innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. They strive to have a remarkable impact on people's lives across several key therapeutic areas including immunology, oncology and neuroscience, and products and services in their Allergan Aesthetics portfolio.
Conducts psychosocial assessments to identify patient and family needs through video technology and telephone calls
Provides grief and bereavement support to patients and families, including anticipatory grief counseling
Completes financial needs assessments and assists with navigation on MediCare, MediCal, Disability and Social Security
Vynca is dedicated to transforming care for individuals with complex needs by providing comprehensive support for more quality days at home. They are a close-knit community guided by core values like Excellence, Compassion, Curiosity, and Integrity.
Play an active role in patient registration and enrollment, including organizing community engagement and outbound calls to patients.
Engage with a panel of assigned patients to provide care navigation, appointment logistics, prescription drug support, lab support, referral coordination, care plan adherence, and resource sharing.
Participate in community events to support patient activation and trust-building, including relationship-building with key contacts, facilitating group education sessions, and liaising with community organizations.
Zócalo Health is a tech-driven healthcare provider built specifically for Latinos, by Latinos, developing a new approach to care designed around shared experiences. Founded in 2021, they are backed by leading healthcare and social impact investors, aiming to improve the lives of communities with culturally competent primary care, behavioral health, and social services.
Engaging patients to deliver services on behalf of their health plan.
Managing a consistent volume of outbound and inbound calls.
Accurately documenting all interactions, interventions, and outcomes.
Arine is a healthcare technology and clinical services company that ensures individuals receive the safest and most effective treatments for their unique healthcare needs. They are a rapidly growing company backed by leading healthcare investors and collaborating with top healthcare organizations and providers.
Provide customers with onsite technology integration, education, and utilization support.
Partner with Sales, Marketing, Customer Training, Customer Services, and Tech Support.
Actively involved in care team training, program support, and continuous improvement initiatives.
Intuitive is a global leader in robotic-assisted surgery and minimally invasive care. Their technologies, like the da Vinci surgical system and Ion, have transformed how care is delivered for millions of patients worldwide. They are a team of engineers, clinicians, and innovators united by one purpose: to make surgery smarter, safer, and more human.
Conduct outbound telephone outreach to patients and engage patients in pharmacist-led consultations.
Serve as a liaison between patients and pharmacies to resolve medication barriers.
Collaborate closely with Care Management Pharmacists to support medication adherence initiatives.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach. They are committed to improving patient outcomes and quality of life by delaying disease progression and shifting care to the home.
Reaches out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc.
Creates cases, tasks, and completes assessments in Case Management module for all Hospital and SNF discharges
Works as a team with the Case Manager to engage and manage a panel of SNP members
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve.
Evaluate client fitness level and skill set to plan reachable goals
Educate and demonstrate to clients exercise and injury prevention
Create a training plan tailored to client needs
Enara is a medical weight loss start-up using data, digital, and clinical treatments. They are based in Silicon Valley and have a mission to develop a platform to scale obesity treatment, using unified products and services for the healthcare ecosystem.